Homestay Application Form

FAMILY NAME*

How did you hear about us?*

Referred by:*

Other:*

HOMESTAY TYPES

We manage 5 distinct programs throughout the year at Shafston. Homestay families are categorised by where they live and if they are willing to care for underage students (18 years and younger).

EXTRA CARE:

STUDY TOURS:

All meals (7 days), laundry and transport to and from the College Monday to Sunday to be provided by the host. Maximum traveling time to the College from the Homestay cannot exceed 50 minutes by car.

REMUNERATION – Up to $65 per night

EXTRA CARE:

All meals (7 days), laundry and transport to and from the College Monday to Friday to be provided by the host. Maximum traveling time to the College from the Homestay cannot exceed 50 minutes by car.

REMUNERATION - Up to $315.00 per week

REGULAR CARE:

FULL BOARD:

All meals (7 days), Students make their own way to and from College and do their own laundry unless the Homestay family chooses otherwise Maximum travelling time to the College from the Homestay cannot exceed 40 minutes using Public Transport.

REMUNERATION: Up to $273.00 per week

HALF BOARD:

Breakfast and Dinner to be provided weekdays. All meals on weekends. Students make their own way to and from College and do their own laundry, unless the Homestay family chooses otherwise. Maximum travelling time to the College from the Homestay cannot exceed 40 minutes using Public Transport.

REMUNERATION: Up to $252.00 per week

NAME AND ADDRESS

Name*

Prefix First Last

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Is your mailing address different from your home address?*

Yes
No

Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Contact Number*

Secondary Contact Number*

Email:*

Enter Email Confirm Email

HOST 1's DETAILS

Name:

First Last

DOB:

Occupation:

Do you have a valid Blue Card?

Yes
No

Blue Card Number:

Expiry Date:

If you do not have a blue card, we will organise this for you upon inspection. Please ensure you have one form of photo identification and another form with a signature during the inspection

If you are under 18 during the period in which a Shafston student is staying in your home, you will not be required to obtain a blue card. For more information please visit: https://www.bluecard.qld.gov.au/

HOST 2's DETAILS

Name:

First Last

DOB:

Occupation:

Do you have a valid Blue Card?

Yes
No

Blue Card Number:

Expiry Date:

If you do not have a blue card, we will organise this for you upon inspection. Please ensure you have one form of photo identification and another form with a signature during the inspection

If you are under 18 during the period in which a Shafston student is staying in your home, you will not be required to obtain a blue card. For more information please visit: https://www.bluecard.qld.gov.au/

OTHER RESIDENT'S DETAILS

Number of Additional Residents:*

RESIDENT 1

Name:*

First Last

DOB:*

Gender:*

M
F

Occupation:*

Do you have a valid Blue Card?*

Yes
No

Blue Card Number:*

Expiry Date:*

If you do not have a blue card, we will organise this for you upon inspection. Please ensure you have one form of photo identification and another form with a signature during the inspection

If you are under 18 during the period in which a Shafston student is staying in your home, you will not be required to obtain a blue card. For more information please visit: https://www.bluecard.qld.gov.au/

RESIDENT 2

Name:*

First Last

DOB:*

Gender:*

M
F

Occupation:*

Do you have a valid Blue Card?*

Yes
No

Blue Card Number:*

Expiry Date:*

If you do not have a blue card, we will organise this for you upon inspection. Please ensure you have one form of photo identification and another form with a signature during the inspection

If you are under 18 during the period in which a Shafston student is staying in your home, you will not be required to obtain a blue card. For more information please visit: https://www.bluecard.qld.gov.au/

RESIDENT 3

Name:*

First Last

Date:*

DOB:*

M
F

Occupation:*

Do you have a valid Blue Card?*

Yes
No

Blue Card Number:*

Expiry Date:*

If you do not have a blue card, we will organise this for you upon inspection. Please ensure you have one form of photo identification and another form with a signature during the inspection

If you are under 18 during the period in which a Shafston student is staying in your home, you will not be required to obtain a blue card. For more information please visit: https://www.bluecard.qld.gov.au/

RESIDENT 4

Name:*

First Last

DOB:*

Gender:*

M
F

Occupation:*

Do you have a valid Blue Card?*

Yes
No

Blue Card Number:*

Expiry Date:*

If you do not have a blue card, we will organise this for you upon inspection. Please ensure you have one form of photo identification and another form with a signature during the inspection

If you are under 18 during the period in which a Shafston student is staying in your home, you will not be required to obtain a blue card. For more information please visit: https://www.bluecard.qld.gov.au/

SMOKING PREFERENCES

Families Smoking Status:*

Smoker
Non-smoker

Preferred Student Smoking Status:*

Smoker
Outside only
Non-Smoker only

HOUSE DESCRIPTION

House Description:*

House
Unit
Apartment

Number of Stories:

1
2
3
4

Type of House:*

Queenslander
Brick
Timber

Located close to:

Parks
Shops
Bus Stops
Other

Please list any additional nearby locations:

Number of:

Bedrooms:*

Bathrooms:*

Kitchens:*

Living Areas:*

Private Bathrooms:*

Pools:*

Entertainment Areas:*

Other:

DESCRIPTION OF STUDENT'S BEDROOMS

Number of Student Rooms:*

1
2
3

Bedroom 1:*

Bedroom 2:*

Bedroom 3:*

Facilities in the Home:*

Please list any additional facilities in your home:

Family Interests:*

Welcome message to Homestay Student:*

(Please provide us with a brief 'Welcome' message. This is seen by our students and agents, when we send your family profile.)

PETS

Number of Pet Types:*

0
1
2
3

PET TYPE 1

Type of Pet:*

Breed of Pet/s:*

How many pets of this type?:*

Name of Pet/s:*

Inside or Outside Pet/s:*

Inside
Outside
Both

PET TYPE 2

Type of Pet:*

Breed of Pet/s:*

How many pets of this type?:*

Name of Pet/s:*

Inside or Outside Pet/s:*

Inside
Outside
Both

PET TYPE 3

Type of Pet*

Breed of Pet/s:*

How many pets of this type?*

Name of Pet/s:*

Inside or Outside Pet/s:*

Inside
Outside
Both

Additional Pet Notes:

OTHER PREFERENCES

Do you have a preference of the student's gender?*

No preferences
Yes - Male only
Yes - Female only

Would you host families or small children?*

Yes
No

Will you host students who have disabilities or medical conditions?*

Yes
No

Will you host students who have dietary requirements?*

Yes
No

Dietary Requirements:*

Halal
Vegetarian
Gluten Free

INTERNET AND TELEPHONE AGREEMENT

**Study Tour and Extra Care students can not be charged for internet usage**

TELEPHONE

The host family DOES or DOES NOT allow students to use their home and or personal phone:*

DOES
DOES NOT

I/WE the host family will charge the following amount per overseas phone call if a student wishes to use the home phone:*

I/WE the host family will charge the following amount per local phone call if a student wishes to use the home phone:*

I / WE understand that Shafston will not accept any responsibility for the bills as they are agreed upon between the Host Family & Student.

HOME INTERNET

The host family DOES / DOES NOT allow student to use their home internet:

DOES
DOES NOT

I / WE the host family understand that if we do wish to provide the students with access to our home internet we must receive payment on a weekly basis and NEVER in advance.

I / WE the host family will charge the following amount per week for the student to use our internet:*

This price will be shown to the student prior to their arrival. If you wish to make any changes to this cost you MUST notify the Shafston Homestay Department prior to accepting any extra money.

I / WE understand that if we are charging more than the above stated price for internet usage we will be liable to reimburse the student of ALL extra costs.

Acknowledgement of Correct Information*

I / WE have provided correct information within this document to the best of our knowledge.

Acknowledgement of Terms and Conditions*

I / WE have read, understood and agree with all Terms and Conditions contained herein.

Host Parent 1

Full Name:*

First Last

Date:*

Host Parent 2

Full Name:

First Last

Date:

Phone

This field is for validation purposes and should be left unchanged.

	46 Thorn St, Kangaroo Point Brisbane QLD 4169 Australia
	+61 (7) 3249 4111
	info@shafston.edu

	13 Nerang St, Southport Gold Coast QLD 4215 Australia
	+61 (7) 3249 4111
	info@shafston.edu

Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

HOMESTAY TYPES

EXTRA CARE:

STUDY TOURS:

EXTRA CARE:

REGULAR CARE:

FULL BOARD:

HALF BOARD:

NAME AND ADDRESS

HOST 1's DETAILS

HOST 2's DETAILS

OTHER RESIDENT'S DETAILS

RESIDENT 1

RESIDENT 2

RESIDENT 3

RESIDENT 4

SMOKING PREFERENCES

HOUSE DESCRIPTION

Number of:

DESCRIPTION OF STUDENT'S BEDROOMS

PETS

PET TYPE 1

PET TYPE 2

PET TYPE 3

OTHER PREFERENCES

INTERNET AND TELEPHONE AGREEMENT

TELEPHONE

HOME INTERNET

Host Parent 1

Host Parent 2